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PRP for Osteoarthritis

Platelet-Rich Plasma injections for arthritis

With each movement, you are reminded of the pain from osteoarthritis.  The medications and therapy have not eased the pain.  Your doctor recommended PRP.  What is osteoarthritis?  What is PRP?  What three joints benefit from PRP for Osteoarthritis?  Let’s dig in.

What Is Osteoarthritis?

To discuss PRP for Osteoarthritis we need to define Osteoarthritis. Arthritis is a general term for painful conditions that involve one or more body joints such as the knee and hip.  Most types of arthritis involve pain, swelling, and stiffness.  There are more than 100 types of arthritis.  Osteoarthritis is the most common form of arthritis affecting more than 30 million adults in the united states (1).  It involves the breakdown of the protective cartilage.  In 2013 osteoarthritis was the second most expensive condition treated in US hospitals accounting for more than $165 billion in hospital costs (2).  Other types of arthritis include rheumatoid arthritis, juvenile arthritis, and gout.

What Is PRP?

PRP stands for Platelet-Rich Plasma.  Platelets are blood cells that prevent bleeding.  They contain important growth factors that aid in healing.  Plasma is the light yellow liquid portion of our blood.  So PRP is simply a concentration of a patient’s own platelets that are suspended in plasma and are used to accelerate healing.  PRP is NOT stem cell therapy.  Regrettably, blood contains few circulating stem cells.   Rich sources of stem cells are bone marrow and fat.

PRP is rich in growth factors.  There are many different types of growth factors with different properties. VEGF is a very important one as it can increase the blood flow to an area.  Blood flow brings important nutrients to damaged tissue and can stimulate repair and healing.  Regrettably, tendons, ligaments, and most parts of the spine have a poor blood supply.  This makes injuries difficult to heal.  PRP can facilitate repair and healing by increasing the amount of blood flow.

To learn more about PRP please click on the video below.

 

 

3 Joints that Benefit from PRP for Osteoarthritis

Knee Osteoarthritis

Knee osteoarthritis is typically the result of wear and tear and progressive loss of the protective cartilage.  Approximately 13% of women and 10% of men aged 60 years and older have symptomatic knee osteoarthritis (3). Risk factors for knee osteoarthritis include old age, female gender, obesity, knee injuries, muscle weakness, and ligament laxity (4).  Is PRP effective in the treatment of knee osteoarthritis?  ABSOLUTELY!!  To date, there are 27 randomized control studies on PRP injections in the treatment of knee osteoarthritis.  A previous blog discussed PRP for Osteoarthritis of the Knee at length.  Key Points:

  • PRP is superior to steroids in reducing pain and increasing function (5, 6)
  • PRP is superior to exercise alone (7)
  • PRP was superior to lubricant knee injections (8)
  • PRP can delay the need for knee replacement (9)

Hand Osteoarthritis

Hand arthritis is common affecting women more than men.  The pain, loss of movement, and loss of strength can be disabling.  Steroids are often recommended but should be avoided as they are toxic to cartilage.   PRP is more effective than steroids in reducing pain and increasing function (10).

Hip Osteoarthritis

Hip osteoarthritis is common with a prevalence of 19.6% in patients 50 years old and over. It is associated with pain, restricted level of activity, diminished mobility, and increased risk for falls.  Lubricant injections called hyaluronic acid (HA) are often recommended when other conservative treatment options fail. These are similar to the lubricant injections used in the knees.

PRP is more effective than hyaluronic acid in reducing pain and increasing function (11).

Arthritis Conditions That Can Be Treated With PRP

Ankle Arthritis

Your ankle is located where the distal ends of the tibia and fibula bones (lower-leg bones) meet the talus bone at the foot. Between these bones are the ankle joints (e.g., tibiotalar, tibiofibular, subtalar, etc.). The ankle joint also consists of strong supporting tendons and ligaments. If you consistently experience ankle pain with walking or running or carrying a heavy load, this could be tendon inflammation, ligament instability, or arthritis in one of those joints.

Read More About Ankle Arthritis

Knee Arthritis

In the human body, a joint is simply where 2 ends of bone come together. At the ends of these bones, there is a thick substance called “Hyaline Cartilage” that lines the ends. Hyaline cartilage is extremely slippery which allows the two ends of the bone to slide on top of each other. Then there is a capsule that connects the two ends filled with “synovial fluid” that acts as a further lubricant to make it more slippery! Arthritis in the knee is defined by loss of the hyaline cartilage plus other changes that happen to the bone such as additional bone being laid down (bone spurs/osteophytes). The cartilage layer is worn down to the point of exposing the underlying bone they cover…

Read More About Knee Arthritis

Related: What to Expect after a PRP Injection

Experts in PRP for Osteoarthritis

At the Centeno-Schultz Clinic, we are experts in the treatment of osteoarthritic conditions.  Treatment options include PRP and bone marrow concentrate injections.  The Centeno-Schultz Clinic was the first clinic in the world to inject bone marrow concentrate into the lumbar spine.  We have published extensively in the field of regenerative orthopedics providing patients an alternative to the risks and complications associated with traditional orthopedic surgery. We have also published our results which are available by clicking here.

In Conclusion

Osteoarthritis can be debilitating.  It is the most common form of arthritis and involves the inflammation of one or more joints, swelling, pain, and stiffness.  When severe it can limit one’s mobility and ability to function.  PRP stands for Platelet Rich Plasma.  It is a concentration of a patient’s own platelets that are suspended in plasma.  PRP is rich in growth factors that can stimulate repair and healing.  PRP for osteoarthritis is effective for patients with ongoing knee, hand, and hip pain and limitations due to osteoarthritis.  Using your own platelets allows patients to avoid the risks of steroids and the complications associated with orthopedic surgery.

Osteoarthritis can rob you of freedom and dignity.  It starts out mild and progresses.  Act now while the issues are small and treatable.  If your doctor tells you that PRP is pixie dust and not supported by evidence please tell him that it is time to attend to his homework.  27 randomized controlled studies exist on the use of PRP in orthopedic conditions.  Contact us today to schedule a telemedicine appointment and learn about your candidacy so that you can live pain-free without dependence on narcotics or NSAIDs. PRP injections in Denver and Broomfield Colorado clinics are conducted by the following doctors:

Doctors Who Treat Arthritis with PRP Injections

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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References

1.Cisternas MG, Murphy L, Sacks JJ, Solomon DH, Pasta DJ, Helmick CG. Alternative Methods for Defining Osteoarthritis and the Impact on Estimating Prevalence in a US Population-Based Survey. Arthritis Care Res (Hoboken). 2016 May;68(5):574-80. doi: 10.1002/acr.22721. PMID: 26315529; PMCID: PMC4769961.

2.Cisternas MG, Murphy L, Sacks JJ, Solomon DH, Pasta DJ, Helmick CG. Alternative Methods for Defining Osteoarthritis and the Impact on Estimating Prevalence in a US Population-Based Survey. Arthritis Care Res (Hoboken). 2016 May;68(5):574-80. doi: 10.1002/acr.22721. PMID: 26315529; PMCID: PMC4769961.

3.Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2(2):205-212.

4.Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010 Aug;26(3):355-69. doi: 10.1016/j.cger.2010.03.001. Erratum in: Clin Geriatr Med. 2013 May;29(2):ix. PMID: 20699159; PMCID: PMC2920533.

5.Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016 Jul-Aug;56(7-8):901-8. Epub 2015 Jul 14. PMID: 26173792.

6.Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2016 Mar;32(3):495-505. doi: 10.1016/j.arthro.2015.08.005. Epub 2015 Oct 1. PMID: 26432430.

7. Rayegani SM, Raeissadat SA, Taheri MS, Babaee M, Bahrami MH, Eliaspour D, Ghorbani E. Does intra articular platelet rich plasma injection improve function, pain and quality of life in patients with osteoarthritis of the knee? A randomized clinical trial. Orthop Rev (Pavia). 2014 Sep 18;6(3):5405. doi: 10.4081/or.2014.5405. PMID: 25317308; PMCID: PMC4195987.

8. Huang, Y., Liu, X., Xu, X. et al. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis. Orthopäde 48, 239–247 (2019). https://doi.org/10.1007/s00132-018-03659-5

9. Sánchez M, Jorquera C, Sánchez P, Beitia M, García-Cano B, Guadilla J, Delgado D. Platelet-rich plasma injections delay the need for knee arthroplasty: a retrospective study and survival analysis. Int Orthop. 2020 Jul 3. doi: 10.1007/s00264-020-04669-9. Epub ahead of print. PMID: 32621139.

10. Malahias MA, Roumeliotis L, Nikolaou VS, Chronopoulos E, Sourlas I, Babis GC. Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage. 2018 Oct 20:1947603518805230. doi: 10.1177/1947603518805230. Epub ahead of print. PMID: 30343590.

11.Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, Tschon M, Giavaresi G. Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Am J Sports Med. 2016 Mar;44(3):664-71. doi: 10.1177/0363546515620383. Epub 2016 Jan 21. PMID: 26797697.